Provider Demographics
NPI:1225125370
Name:GURULE, MANUEL D (PA-C)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:D
Last Name:GURULE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:303-493-7001
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:B060
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6600
Practice Address - Fax:720-777-7268
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO689363AS0400X
COPA.0000689363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1225125371Medicaid
KS200003940BMedicaid
WY1225125370Medicaid
CO23000872Medicaid
COS15722Medicare UPIN
WY1225125370Medicaid